Long-term fracture risk among women with anorexia nervosa: A population-based cohort study

Objective: To determine if fractures represent an important problem for women with anorexia nervosa who may fail to achieve peak bone mass and may experience premature bone loss from decreased estrogen levels. Patients and Methods: In this population-based retrospective cohort study, we identified 208 Rochester, Minn, residents that were first diagnosed as having anorexia nervosa between 1935 and 1989, whose subsequent fractures were documented in contemporary medical records and compared with expected numbers of fractures (standardized incidence ratios [SIRs]). Results: Subjects were followed up for 2689 personyears during which time 45 patients suffered 88 fractures. Fracture risk was increased among the 193 women (SIR, 2.9; 95% confidence interval, 2.0-3.9) as well as the 15 men (SIR, 3.4; 95% confidence interval, 1.1-7.9). The cumulative incidence of any fracture at 40 years after the diagnosis of anorexia nervosa was 57%. Fractures of the hip, spine, and forearm were late complications, occurring on average 38,25, and 24 years, respectively, after diagnosis. Conclusion: Young women with anorexia nervosa are at increased risk of fractures later in life. Greater attention should be paid to the skeletal health of these individuals.